Wednesday, June 15, 2011


     A month ago, on a Wednesday afternoon at 3:59 p.m., I witnessed my first hospice patient -- indeed, my first human being -- die.  L.S. had been admitted a few days earlier to the 36-bed hospice hospital where I volunteer once a week to sit with so-called "actively dying" patients.  Her condition had worsened the night before, and when I arrived at 2 p.m. she was semi-comatose and unresponsive.  No one was with her.

     Like almost all such patients, she was breathing in widely-spaced, softly agonal, gasps.  Her mouth hung open, slack-jawed.  Her eyes were half-open, glazed, unseeing.  For two hours, her breathing got more and more labored, until finally she took a couple of breaths a half-minute apart, lifted herself slightly from the bed, widened her eyes, and made a soft, clicking noise in her throat.  Then she gently deflated, like a balloon  losing air.  Her eyes narrowed and her chin slumped down against her right shoulder.

     Contrary to popular myth, many people at this stage of dying don't want to be touched, so till now I'd just been sitting close by, waiting to see what, if anything, L.S. might need or want.  Suspecting she was dead, I stood up to get a closer look at her face and noticed her hands were moving slightly under the bedsheet.  Instinctively I took them in my hands, whispering to her to relax, let go, accept.  Almost at once the hands  stopped moving. 

     I'd like to think we'd communicated, but I'm pretty sure she'd already died and was merely having mild, postmortem, muscular contractions, a hunch the nurse confirmed when she arrived a minute later.   Besides, whether or not L.S. knew I was holding her hands seemed trivial in comparison to the peacefulness,  serenity, and painlessness of her dying, which had been remarkably unstressful and untraumatic.  She showed no sign of suffering during her final minutes.

     To me, this was just as it should have been.  I see death as the absolutely terminal event of every human life.  It ends the chain of natural processes that begins in conception, continues with birth, growth, maturation, and aging, and concludes by re-submerging all human beings in the oblivion of inorganic matter from which  they emerge.  Never easy, death flat-out contradicts all the survival instincts ingrained in us by millions of years of evolution.  We not merely want to live but viscerally hope never to die.  Of course, reason and  experience inevitably teach us otherwise.  Yet billions of people worldwide choose to deny the finality and irreversibility of their impending death by trying to believe in some kind of afterlife.

     I think this widespread human refusal to accept and deal with the reality of death is due in large part to the suffering it often causes people who are fatally injured or dying of disease.  The possibility of  excruciating,  unrelieved pain under such circumstances is as horrifying to most people as it is to me.  The thought that I or someone I love might have to endure such agony fills me with fear and loathing.  I've no doubt that much of humanity's hatred of death stems from this same fear and loathing of dying in agony, which has helped drive human death almost entirely out of sight in the modern world.  Few people ever see other people die nowadays except in wars, natural disasters, or hospitals. 

     I volunteered for "actively dying" hospice work in order to reestablish personal contact with this tremendous, final event in human existence.  After almost a year and vigils with more than fifty patients, almost all of whom have died within hours or at most days of my being with them, I find myself deeply  moved by and committed to the task.  The main reason is that I've discovered that almost all my patients, like L.S., have been free of pain, anxiety, or even minor discomfort.  My hospice hospital, like all good ones, gives its patients the best palliative care available.  Qualified doctors visit and examine every patient every day.  Each nurse is responsible for roughly ten patients a shift, and every shift is manned 24-7.  Aides feed, clean, and reposition the patients around the clock.  No effort is made to cure the patients of anything, only to mitigate their suffering.

     Volunteers like me play a useful role in this palliative approach.  Because I sit with patients who at the time have no friends or relatives visiting them, and because such patients are normally incapable of calling  for help, I watch them closely for signs of distress and summon the nurse when I see such signs develop.  More often than not, as a result of my calls, the nurses will give the patients extra pain-killing, anti-anxiety, anti-coagulant, or other medicine, which always helps soothe and stabilize them.

     To me, this is the best thing I can possibly do for a fellow human being in such circumstances, and I get much fellow-feeling and satisfaction from doing it.  I also find that making the dying moments of my patients as painless and stress-free as possible is yet another consoling side-benefit of my atheistic materialism, which holds that human sentience is finite and ephemeral but its origins and sources in material nature are infinite and permanent.  In other words, I take great comfort in doing everything I can to ease my patients into death because I sincerely believe, first, that however menacing it may seem, death is nothing but a short passage from human sentience to the peace and quiet of natural oblivion and, second, that every human being's material remains -- his or her post-death molecules -- are somehow inextricably linked to a limitless All of material being.  Though our conscious, human existence ends with death, our unconscious, material existence persists indefinitely, in ways we don't know or understand.  Some unimaginable kind of material stuff or energy underlies and unites all natural existence, which is the only kind of existence there is.

     I have no intention of hastening or in any way causing the death of my patients or of any one else.  While open-minded on the subject of suicide, I'm strongly opposed to anyone committing it on or for someone else in any but the most extreme and unusual circumstances, and I abominate killing one's self in order to kill others, like a suicide bomber.  Naturally, I also totally oppose assisted suicide in connection with any kind of hospice program.  As explained above, the whole point of good hospice care is to palliate the dying process by making it as painless and stress-free as possible.  Once someone is diagnosed as likely to die within six months, he or she should be treated palliatively, not curatively, and all further efforts to forestall or avoid death should stop.  At that point, hospice takes over, making suicide unnecessary and irrelevant.

     .A final consolation that I as an atheist find in the palliative approach to death is that it lessens pressure on the dying, judging from my own hospice experience, to try to confront death heroically -- to "look it square in the eye" or "meet it head on," as the cliches say.  Anyone who wants to experience the full measure of agonal death of course can, like the (rare) person who refuses novacaine at the dentist's office.  But since I grew up in a time and place where many dentists didn't use novacaine and  remember keenly what it felt like having my teeth pulled or drilled without anesthesia, I'm no longer in the least heroic about pain.  Like most people, I'm happy to take advantage of every pain-killing medicine modern science has devised.  I do not long for the good old days of block-and-tackle, anesthesia-free surgery -- or dying.